Cholestatic Bradycardia: The Story of Rising Bilirubin and a Slowing Heart: A Case Report of a 74 Years Old Female Patient at the University of Nigeria Teaching Hospital in Enugu, Nigeria | Chapter 8 | Recent Updates in Disease and Health Research Vol. 6

 

The association between Cholestatic jaundice and bradycardia has been well documented with reports of a variety of bradyarrhythmias. Although its actual mechanism of development has remained elusive to clinicians, bradycardia/ bradyarrhythmia has however been known to complicate the course and outcome of obstructive jaundice. Here we report the case of a 74-year-old woman with obstructive jaundice secondary to carcinoma of the head of the pancreas. As her serum bilirubin and bile acids continued to rise she developed progressive bradycardia and other dysrhythmias, manifesting with syncope and was referred to us, cardiologists, for correction. By vagal antagonism, enhancement of bile acid elimination, and surgical biliary diversion under temporary pacemaker support, the rhythm disorders were reversed.

Methods: Serial serum bilirubin and bile acids assay and electrocardiogram (ECG) were done every three days. The total/direct bilirubin rose progressively from 28.4/17.6 umol/L at the outset to 501.5/234.0 umol/L. The bile acids equally increased steadily from Aspartate Transaminases/ Alanine Transaminases/ Alkaline Phosphatase (AST/ALT/ALP) levels = 96/81/1037 IU/L to as high as AST/ALT/ALP = 580/400/7000 IU/L. Patient manifested cardiac rhythm disorders including sinus bradycardia with first-degree atrioventricular (AV) block and heart rate (HR) of 54/min, Mobitz type 2 AV block (HR =40/min), and Complete heart block (HR=33/min) over two weeks period.

Results: Following the commencement of bile acid eliminants, vagal stimulation antagonists, and surgical biliary diversion under temporary pacemaker support, reversal of the bradyarrhythmias was achieved and HR normalized within 3 3-week periods.

Conclusion: This case demonstrated that cholestatic bradycardia is reversible if well-managed.

 

Author(s) Details:-

 

Nkeiruka C. Mbadiwe

Department of Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria.
Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

 

Please see the link here:  https://doi.org/10.9734/bpi/rudhr/v6/8391E

Study on Left Ventricular Pacing: A Desperate Lifesaving Measure in Emergency Situation | Chapter 4 | Highlights on Medicine and Medical Science Vol. 5

 Transcutaneous or transvenous pacing of the right ventricle is routinely performed in the cath lab for patients with symptomatic bradycardia or complete heart block. Because it is one of the most important lifesaving interventions in cardiology, temporary transcutaneous or transvenous pacing is often the first intervention taught to cardiologists and intensivists. However, an increasing number of patients are being admitted with multiple comorbidities, critical conditions, and difficult vascular access. The purpose of this study is to describe a patient who underwent coronary angiography with difficult venous access, tricuspid regurgitation, and a displaced right ventricular pacemaker temporary lead and was treated with emergent nonconventional left ventricular pacing.

Author (S) Details

Dr. Ajaz Ahamad Lone
Department of Cardiology, SKIMS, Srinagar, Jammu and Kashmir, India.

Dr. Mohd Iqbal Dar
Department of Cardiology, SKIMS, Srinagar, Jammu and Kashmir, India

Dr. Fayaz Ahamad Rather
Department of Cardiology, SKIMS, Srinagar, Jammu and Kashmir, India.

Dr. Mohd Sultan Alai
Department of Cardiology, SKIMS, Srinagar, Jammu and Kashmir, India.

Dr. Imran Hafiz
Department of Cardiology, SKIMS, Srinagar, Jammu and Kashmir, India.

Dr. Jahangir Rashid Beigh
Department of Cardiology, SKIMS, Srinagar, Jammu and Kashmir, India.

View Book :- https://stm.bookpi.org/HMMS-V5/article/view/1729

Double Edged Sword Cardiac Side Effect of Ondansetron: A Case Report | Chapter 6 | Highlights on Medicine and Medical Research Vol. 9

Sudden onset of bradycardia during the intra-operative period under anaesthesia is relatively uncommon. It's possible. Deeper planes of anesthesia, high spinal anesthesia, a surgical stimulus of the parasympathetic system, pre-existing cardiac illness, beta-blocker medication, or intraoperative medications such as Clonidine, Dexmedetomidine may all contribute to this. Arrhythmias in the heart have been linked to ondansetron, particularly in those with a prolonged QT interval. In this chapter, we provide the sixth case of Ondansetron-induced acute bradycardia that, when treated, resulted in atrial and ventricular ectopics with hypertension in a 25-year-old female patient who was scheduled for an elective Lower Segment Caesarean Section. We are convinced that Ondansetron is to blame for this patient's abrupt onset of bradycardia, because although having SLE, she showed no symptoms of the disease's cardiac involvement.

Author (s) Details

Dr. Reena R. Kadni
Department of Anesthesiology, Bangalore Baptist Hospital, Bangalore, Karnataka, India.

View Book :- https://stm.bookpi.org/HMMR-V9/article/view/1026